Low Risk of Hepatitis B Virus Reactivation in HBsAg-negative/Anti-HBc-positive Carriers Receiving Rituximab for Rheumatoid Arthritis: A Retrospective Multicenter Italian Study

被引:43
|
作者
Varisco, Valentina [1 ]
Vigano, Mauro [2 ]
Batticciotto, Alberto [1 ]
Lampertico, Pietro
Marchesoni, Antonio [3 ]
Gibertini, Patrizia [3 ]
Pellerito, Raffaele [4 ]
Rovera, Guido [4 ]
Caporali, Roberto [5 ]
Todoerti, Monica [5 ]
Covelli, Michele
Notarnicola, Antonella [6 ]
Atzeni, Fabiola [1 ]
Sarzi-Puttini, Piercarlo [1 ]
机构
[1] Osped L Sacco, Rheumatol Unit, Via GB Grassi 74, I-20157 Milan, Italy
[2] Univ Milan, Osped San Giuseppe, Hepatol Unit, Milan, Italy
[3] Ist Ortoped G Pini, Rheumatol Day Hosp, Milan, Italy
[4] Osped Mauriziano Umberto 1, Rheumatol Unit, Turin, Italy
[5] Univ Pavia, IRCCS Fdn San Matteo, Div Rheumatol, Pavia, Italy
[6] Azienda Osped Univ AOU Policlin, Univ Rheumatol Dept, Bari, Italy
关键词
HEPATITIS B VIRUS REACTIVATION; HBsAg; HBV DNA; RITUXIMAB; RHEUMATOID ARTHRITIS; CELL LYMPHOMA PATIENTS; CHEMOTHERAPY; INFECTION; MANAGEMENT; DISEASE; EPIDEMIOLOGY; PROPHYLAXIS; COMBINATION; ANTIBODY; PATIENT;
D O I
10.3899/jrheum.151105
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. Patients with resolved hepatitis B virus (HBV) infection, i.e., hepatitis B surface antigen (HBsAg)-negative/antihepatitis B core antigen (anti-HBc)-positive, undergoing rituximab (RTX)-based chemotherapy for hematological malignancies without anti-HBV prophylaxis are at risk of HBV reactivation, but the risk in such patients receiving RTX for rheumatological disorders is not clear. We evaluated this risk in HBsAg-negative/anti-HBc positive patients with rheumatoid arthritis (RA) undergoing RTX without prophylaxis. Methods. Thirty-three HBsAg-negative/ anti-HBc-positive outpatients with RA with undetectable HBV DNA by sensitive PCR assay [73% women, median age 60 years, 85% with HBsAg antibodies (anti-HBs), 37% with antihepatitis B envelope antigen] received a median of 3 cycles of RTX (range 1-8) over 34 months (range 0-80) combined with disease-modifying antirheumatic drugs (DMARD) without prophylaxis. All underwent clinical and laboratory monitoring during and after RTX administration, including serum HBsAg and HBV DNA measurements every 6 months or whenever clinically indicated. Results. None of the patients seroreverted to HBsAg during RTX treatment, but 6/28 (21%) showed a > 50% decrease in protective anti-HBs levels, including 2 who became anti-HBs-negative. One patient (3%) who became HBV DNA-positive (44 IU/ml) after 6 months of RTX treatment was effectively rescued with lamivudine before any hepatitis flare occurred. Among the 14 patients monitored for 18 months (range 0-70) after RTX discontinuation, no HBV reactivation was observed. Conclusion. The administration of RTX + DMARD in patients with RA with resolved HBV infection leads to a negligible risk of HBV reactivation, thus suggesting that serum HBsAg and/or HBV DNA monitoring but not universal anti-HBV prophylaxis is justified.
引用
收藏
页码:869 / 874
页数:6
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